CMS Proposes Revisions to Medicare Payment Policies by 2027

The Centers for Medicare & Medicaid Services (CMS) has recently unveiled a proposed rule aimed at revising Medicare payment policies and rates for hospital outpatient and ambulatory surgical center services by 2027. This proposed adjustment, part of the Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System Proposed Rule, aligns with the agency's annual regulatory compliance requirements, ensuring the timely update of payment policies for these healthcare facilities.

In a related move, CMS has suggested amendments under the Home Health (HH) Prospective Payment System to guarantee annual updates impacting home health agencies. Furthermore, the Medicare GLP-1 Bridge Program introduces Medicare beneficiaries to certain medications at $50 monthly, expanding access to innovative treatments and assessing their impact on the program.

Additional guidance from CMS includes instructions for hospitals on encoding outlier contracting clauses in machine-readable files, as outlined in the updated Hospital Price Transparency FAQs. Laboratories can now determine their applicable status under the Clinical Laboratory Fee Schedule by reviewing data submission requirements active from May 1 to July 31, 2026. Meanwhile, an Office of Inspector General report identifies compliance issues in skilled nursing facilities, with overstated related party costs on Medicare Cost Reports.

Addressing Transmittal 13805, Change Request 14513, CMS intends to uphold existing fees for specific HCPCS codes, mandating the use of the KF modifier for future claims. These changes will be reflected in the revised July 2026 DMEPOS fee schedule. Stakeholders are encouraged to stay updated by accessing CMS resources and newsletters, such as the Medicare Learning Network, which provide thorough regulatory and instructional content.